WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20170019
OBJECTING PARTY: Worker
REPRESENTED by: Legal
RESPONDENT: Employer (not participating)
HEARING: Hearing in Writing
DATE: June 14, 2017
ISSUES
The worker is seeking:
Entitlement for spinal stenosis, denied on June 19, 2015;
Entitlement for disc protrusions and bulges in the thoracic and lumbar spine denied on July 26, 2016;
Ongoing entitlement to loss of earnings (LOE) benefit, denied on June 19, 2015.
BACKGROUND
The worker was employed as a driver for a petroleum company. On January 22, 2015, at age 39, he developed pain in his mid-back while rolling a 250 litre drum of oil and lifting it to an upright position. He then had to climb a moving ladder while holding a fill hose and felt pain in his lower back. He sought medical attention on January 23, 2015. Entitlement was accepted for a sprain/strain of his upper and lower back. LOE benefits were paid to May 29, 2015 because suitable work wasn’t available with the employer.
Decisions
The decision of June 19, 2015 determined the worker had reached full recovery from his work-related back strains with no ongoing entitlement. The diagnosis of spinal stenosis was determined to be not compatible with the mechanism of injury in this claim.
The decision of July 26, 2016 determined the disc bulges and protrusions were not related to the workplace injury of January 22, 2015.
AUTHORITY
Operational Policy
15-02-03 Pre-existing Conditions
11-02-02 Lost Time Claims
ANALYSIS
I have considered all of the available information, legislation and relevant operational policies in reaching this decision.
Spinal Stenosis
I find there is no entitlement for spinal stenosis. My reasons are explained below.
An MRI of the thoracic and lumbar spine on March 5, 2015 showed central spinal stenosis at L3-4, with foraminal narrowing and osteoarthritic changes of the facet joints. The file was reviewed by a Physician Consultant on April 9, 2015. The opinion noted the worker’s upper back symptoms had improved with physiotherapy, but he continued to have symptoms of burning, numbness and weakness in the L-3 dermatome when walking or standing for more than 10 minutes. The opinion indicated these symptoms were consistent with the lumbar spinal stenosis shown on the MRI. The Physician Consultant’s opinion was that the spinal stenosis was not compatible with the work injury, and was instead the result of an underlying pre-existing condition.
According to Operational Policy 15-02-03, the Workplace Safety and Insurance Act, 1997 (WSIA) directs that compensation be provided for work-related injuries. Entitlement is not granted for injuries resulting from other factors, such as non-work-related pre-existing conditions. Decision-makers continue to evaluate the work-relatedness of a worker’s ongoing impairment throughout the life of a claim. Pre-existing conditions include but are not limited to:
conditions that have produced periods of impairment requiring health care and have caused a disruption in employment prior to the workplace injury;
underlying or asymptomatic conditions which only become manifest post-accident;
work-related permanent impairments for which the WSIB has granted a permanent disability or Non-Economic Loss (NEL) benefit.
In the absence of any conflicting medical opinions, I accept the opinion from the Physician Consultant that the spinal stenosis was a pre-existing condition.
In his submission dated July 13, 2015, the worker argued the pre-existing spinal stenosis was fast-tracked or aggravated by the workplace injury but I find the balance of the evidence does not support his position. The evidence shows the worker had chronic back pain with symptoms in his legs prior to the workplace injury. In a discussion with the Eligibility Adjudicator on February 4, 2015, the worker confirmed that prior to the work injury, about once a month he got shooting electric feelings down his legs if he pushed himself too hard. On November 11, 2012 the worker was seen at a hospital emergency and the report documented a one year history of back pain and bilateral leg numbness with standing. The diagnosis was acute on chronic back pain. The file was further reviewed by a Physician Consultant on June 21, 2016 and the opinion suggested that the similarity of the symptoms reported in 2012 and since the workplace injury suggested the spinal stenosis may have been present for several years prior to the work injury.
In summary, based on the medical evidence and opinions I find the spinal stenosis was a symptomatic condition prior to the workplace injury and the evidence does not show the condition was significantly aggravated or worsened by the workplace injury. For these reasons, I find there is no entitlement for spinal stenosis.
Disc Bulges and Protrusions
I find there is no entitlement for disc bulges and protrusions in the thoracic or lumbar spine.
The MRI of March 5, 2015 showed mild multilevel degenerative changes with tiny disc protrusions at T4-5 and T8-9, central spinal stenosis at L3-4 and foraminal narrowing with osteoarthritic changes of the facet joints.
The worker representative provided a submission with the Appeal Readiness Form dated March 6, 2017. It is his position the disc protrusions at T4-5 and T8-9 are consistent with the upper back injury the worker sustained at work.
The file review completed by a Physician Consultant on June 21, 2016 indicated that while the disc protrusions at T4-5 and T8-9 could be compatible with the mechanism of injury, the medical documentation did not support that the tiny protrusions were the source of any clinically significant symptoms or impairment. The remainder of the findings on the MRI were considered to be pre-existing degenerative changes, not causally related to the work injury and more likely related to the worker’s body habitus. The worker also has another risk factor contributing to the condition of his spine. The report from an orthopaedic surgeon dated April 13, 2015 noted the worker was morbidly overweight, carrying at least 100 lbs in excess of his ideal weight.
After considering the medical evidence and opinions, I find the disc protrusions and bulges were not likely caused by the work injury and are not the source of any clinically significant impairment.
Ongoing Entitlement and LOE Benefits
I find there is no ongoing entitlement in the claim.
According to Operational Policy 11-02-02, decision-makers review the information on file to determine a worker's entitlement to benefits. Clinical evidence on file must show that the inability to work is due to the work-related injury. If the worker does not have clinical authorization to be off work, wage loss benefits or loss of earnings benefits cannot be paid. Decision-makers monitor, assess and weigh the health care information in the worker's claim file to determine whether the worker has recovered from his work-related injury.
Having determined there is no entitlement for the spinal stenosis or the disc bulges, I find the work related back sprains/strains have resolved. There is little in terms of updated medical information to support an ongoing work-related impairment. On June 23, 2015, the worker’s doctor completed an Attending Physician’s Statement of Disability, which indicated the primary diagnoses as lumbar disc disease, lumbar spinal stenosis and herniated disc at T8-9, causing disabling pain and numbness in his legs on standing for more than 5 minutes. This supports the conclusion that any ongoing symptoms are the result of pre-existing conditions.
According to Operational Policy 15-02-03, in some cases the clinical evidence may demonstrate that the significance of the pre-existing condition is so great it has overwhelmed the impact of the work-related injury, rendering it insignificant. When this occurs, the work-related injury cannot be considered to be of sufficient significance in comparison to the pre-existing condition, for benefits to continue.
In summary, I find the work-related upper and lower back sprains/strains have resolved with no ongoing impairment. There is no entitlement to additional LOE or health care benefits.
CONCLUSION
I conclude:
There is no entitlement for spinal stenosis.
There is no entitlement for disc protrusions and bulges in the spine.
There is no ongoing entitlement in the claim as the worker has recovered from the workplace injury as determined in the decision of June 19, 2015. There is no additional entitlement to LOE or health care benefits.
The objection is denied.
DATED June 14, 2017
H. Shaw
Appeals Resolution Officer
Appeals Services Division